An approach to…KNEE EXAM

* as with all rheumatologic exams, note patient comfort and compare bilaterally

 

Inspection

 

S    Swelling - look for loss of normal hollow around patella

E    Erythema

A   Atrophy of quadriceps muscle (measure quadriceps size 15 cm above tibial tubercle)

D   Deformity (varus/valgus/recurvatum, symmetry, alignment)

S    Skin changes (scars, bruising)

     

      Stance

      Gait      - Abnormal movements used to compensate for pain in knee joint

 

      Crouch compression test

            - Anterior pain → patellofemoral

            - Lateral or medical joint line pain → meniscal problem

     

Palpation – tenderness, effusion, swelling, temperature, crepitus, atrophy

 

- Knee extended

- Tenderness, effusion, nodules, or warmth

 

Patella (effusions are companied by warmth)

Patellar tendon

            Tibial tuberosity

            Medial fat pad – tender in fibromyalgia

 

- Knee flexed (30°)

 

Femoral condyles

Tibiofemoral joint line (lateral aspect for meniscal cysts)

MCL, LCL

Tibial tubercle

 

Bursa : prepatellar, infrapatellar, suprapatellar, anserine (bursitis → pain)

Popliteal fossa (Baker’s cyst, politeal artery)

           

Effusions

 

- Wipe/bulge test:

Stroke upwards on medial side of the knee to milk fluid to the lateral compartment, then stroke downwards on lateral side of the knee and observe for fluid returning to the medial compartment 

 

- Ballotment/Patellar tap (L hand on suprapatellar – feel with R)

Squeeze fluid out of the suprapatellar pouch and then while maintaining pressure (holding on to the tendon), push down quickly on the patella to produce a palpable click in the other hand

 

ROM

 

      Active vs Passive

            - Flexion/Extension (genu recorvatum)

            - Internal/External rotation (10°)

 

Stability

- Feel for a solid end point; if ligament torn, the end of ROM would be soft

 

MCL: valgus stress test

LCL: varus stress test

ACL: anterior drawer test, Lachman

PCL: posterior drawer test

 

- Lachman’s externally rotate hip, bend knee 15^o, pull up on tibia and push back on femur)

 

Meniscal

 

- Crouch compression test (already complete)

- McMurray’s test (patient supine, knee bent at 90°, feel for obvious click along joint line on medial/lateral sides)

- Medial meniscus: externally rotate, place valgus force on knee, and extend

            - Lateral meniscus: internally rotate, place varus force on knee, and extend